TLDR:   

Well … it wasn't all good news this time.  My BP was good and my resting heart rate was good, but ... my tumor marker was detected again.  It hadn't been detected in the previous three checkups, which is what you want to see after chemotherapy.  The marker for seminoma isn't great, so it could just be a blip or showing up for causes unrelated to cancer.  But it also could mean that the tumor is still ticking and is starting to grow again.  They didn't move up my next checkup (2 months from now), but they had already had a conversation about what might come next if the marker doesn't disappear by then.  So basically, my test results were pretty much in line with the rest of 2020 – you just wait for another shoe to drop.   

The long version - 

It's been a couple of months since my last checkup, but MD Anderson is basically the same.  You park in the garage and there's only one elevator to the first floor.  Everybody goes through it.  They have an IR scanner overhead when you go in, so they know whether you're running a fever or not.  You get a new mask, and then you wait in a socially distanced line to answer questions about whether you've had a fever or a cough or tested positive for CoV2.  If you get all the answers right, you get a green wristband and go on your way.   

I got bloodwork first – the phlebotomist told me that they had sent all the other phlebotomists around MD Anderson to keep them distanced, but they still sent a huge number of patients through this lab.  Next came a chest/abdomen x-ray.  And then, I settled in the waiting room for an hour and a half until they called me in.   

Usually, when the doctor comes in, she says "it's good news", but she didn't do that this time.  She started to go through my bloodwork and told me that my tumor marker was detected at low levels.  For the nerds among us, it was just above the detection/reporting limit (apparently they're the same for this instrument).  It was many orders of magnitude higher last September before chemo started, and then it dropped below detection limits by the time chemo had been completed in December.  

The marker, for those of you who are interested, is beta hCG, or human chorionic gonadotropin.  This hormone promotes the development of the placenta (the chorion is the membrane surrounding the fetus that eventually becomes the placenta).  So obviously, if a guy has high levels of this in his blood, it's just weird.  One of my biggest regrets of last year is that I didn't pee on a pregnancy test, because it would have been positive (many pregnancy tests detect hCG).  That's just comedy.      

She said it could just be a blip, that they see that sometimes.  She asked me if I had been smoking marijuana and I told her that I am still the only folk singer in America who has never tried it.   If the level had been higher, they would have immediately moved to do more imaging, but with this you just wait and see.  They're not moving up my next checkup (in September), so that was reassuring.   

But when I asked what might come next, she said you think about the path between chemo or radiation and it would most likely be radiation.  She and my oncologist had clearly discussed it, which wasn't quite as reassuring.  For just a moment, I was back in that hospital room where I had chemo, tethered to an IV pole and waiting for the damn infuser alarm to go off again.  She performed another testicular exam (which as you may recall is code for a woman fondling stuff) and didn't detect anything.   

Yeah, It's probably just a blip and will be gone again by September.  But this is 2020 – so we can't rule out the possibility that my tumor is going to rip out of my abdomen Alien-style and terrorize south Houston.  If I wind up having to have radiation, I believe that is outpatient so at least I wouldn't be back eating hospital food and walking among all the other sad stories in the genitourinary ward.  If nothing else, today was a reminder that I am indeed still a cancer patient.  I realized I hadn't been thinking of it that way for a while now.     
 
I know, I'm getting way ahead of myself – but hey, would I still be myself if I didn't do that?